System and method for location determination using movement between optical labels and a 3d spatial mapping camera

ABSTRACT

A system determining a location for a surgical procedure, the system including a jig having a frame, a first marker fixed to the frame, wherein the first marker includes a scanable label, and a second marker moveably connected to the frame, such that the second marker can move positions independent of the frame, and wherein the second marker includes a scanable label. The system also includes a mixed reality headset configured to scan the scanable label of the first marker and the scanable label of the second marker, to provide location data to the mixed reality headset.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of non-provisional U.S. patentapplication Ser. No. 17/486,704, filed on Sep. 27, 2021, which is acontinuation of non-provisional U.S. patent application Ser. No.17/373,613, filed on Jul. 12, 2021, which is a continuation ofnon-provisional U.S. patent application Ser. No. 17/169,289, filed onFeb. 5, 2021, which is a continuation of non-provisional U.S. patentapplication Ser. No. 17/030,352, filed on Sep. 23, 2020, which is acontinuation of non-provisional U.S. patent application Ser. No.16/994,663, filed on Aug. 17, 2020, which is hereby incorporated byreference herein in its entirety, including but not limited to thoseportions that specifically appear hereinafter, the incorporation byreference being made with the following exception: in the event that anyportion of the above-referenced application is inconsistent with thisapplication, this application superseded said above-referencedapplication.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable.

BACKGROUND 1. The Field of the Present Disclosure

The present disclosure relates generally to surgical systems and methodsof facilitating the efficiency and accuracy of implanting surgicalprostheses using moveable jig labels, mixed reality and 3D spacialmapping devices.

2. Description of Related Art

In traditional implant surgeries, for example, knee replacements, asurgeon will utilize a metal jig which is used as a drilling or cuttingguide to make the necessary corresponding cuts and holes in the bone ofthe knee to facilitate placement and attachment of the implant to thebone. However, these metal jigs must be stocked in a variety ofdifferent sizes to accommodate different needs and sizes of patients,accordingly, significant stocks of metal jigs must be stored andsterilize. Additionally, use of these metal jigs include inherentinaccuracies as the surgeons fix the metal jigs with respect to thecorresponding bone during use as a drill or cutting guide.

The femoral implant and tibial implant are designed to be surgicallyimplanted into the distal end of the femur and the proximal end of thetibia, respectively. The femoral implant is further designed tocooperate with the tibial implant in simulating the articulating motionof an anatomical knee joint.

These femoral and tibial implants, in combination with ligaments andmuscles, attempt to duplicate natural knee motion as well as absorb andcontrol forces generated during the range of flexion. In some instanceshowever, it may be necessary to replace or modify an existing femoraland/or tibial implant. Such replacements are generally referred to asrevision implants.

To prepare a femur and tibia for such a knee replacement and form anengagement with femoral and tibial implants, the femur and tibia bonesmust be cut in very specific and precise ways and at very specific andprecise angles and locations, so that the prepared bone will properlyengage with and be secured to the corresponding implants. In order tomake these cuts properly, a surgeon traditionally uses a jig, orsurgical cutting guide as known to those skilled in the field, which canbe removably attached or secured to the bone, such that slots, orguides, in the jig facilitate the precise cuts necessary to secure thecorresponding implants.

The phrase “jig” as used herein, shall thus refer broadly to a surgicalcutting guide, that may be configured and arranged to be fixed orattached to a bone, or may be secured adjacent to a bone or other tissueto be cut by a surgeon an identify a relative location, angle and orcutting plane that a surgeon should cut on the adjacent bone or tissue,as known in the art. A jig may include predetermined slots and/orcutting surfaces to identify where a surgeon should cut the adjacentbone or tissue, wherein such cuts may correspond to a shape of asurgical implant that may be attached to the cut bone or tissue. A“cutting surface” may refer to a guide edge for guiding the path of acutting instrument.

Conventional jigs are typically made of a metal alloy and, due to theprecise tolerances at which these jigs must be machined, are quiteexpensive, ranging as high as $40,000-$50,000 in some cases. These metaljigs must also be stored and reused, which adds additional cost andspace resources. Additionally, jigs of various sizes must be kept on hadto accommodate patients of different sizes and needs.

Therefore, there is a need for a system that can utilize a lessexpensive jig, such as a plastic jig, that could be made easily and ondemand, while maintaining the required tolerances and enable the sameaccuracy in use in a surgical procedure.

In other conventional embodiments, holographic jigs, also referred to avirtual jigs, have been used to enable a surgeon to visualize thepositioning and proper sizing of a jig to a bone. However, in use, whenthe surgeon attempts to superimpose a physical jig over the virtual jigto attach it to a bone to make the required bone cuts, the physical jigwill impair the view of the virtual or holographic jig, making itdifficult to utilize the holographic jig to accurately place thephysical jig.

Accordingly, there is a need for a system and method of utilizing avirtual or holographic jig or surgical instrument that could facilitateincreased accuracy and precision of required or desired bone cuts.

The phrase “virtual jig” or “holographic jig” as used herein, shall thusrefer broadly to any visual rendering or projection representing anactual physical jig, having all, or mostly all, of the same visualcharacteristics of the physical jig, including size and shape, as knownin the art.

The features and advantages of the present disclosure will be set forthin the description which follows, and in part will be apparent from thedescription, or may be learned by the practice of the present disclosurewithout undue experimentation. The features and advantages of thepresent disclosure may be realized and obtained by means of theinstruments and combinations particularly pointed out in the appendedclaims. Any discussion of documents, acts, materials, devices, articlesor the like which has been included in the present specification is notto be taken as an admission that any or all of these matters form partof the prior art base, or were common general knowledge in the fieldrelevant to the present disclosure as it existed before the prioritydate of each claim of this application.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the disclosure will become apparent froma consideration of the subsequent detailed description presented inconnection with the accompanying drawings in which:

FIG. 1 is a schematic rendering of a mixed reality system of the presentdisclosure;

FIG. 2 is a front view of a jig of the present disclosure;

FIG. 3 is a side view of the jig of FIG. 2;

FIG. 4 is a perspective view of a jig and mounting plate of the presentdisclosure; and

FIG. 5 is a side view the jig and mounting plate of FIG. 4.

DETAILED DESCRIPTION

For the purposes of promoting an understanding of the principles inaccordance with the disclosure, reference will now be made to theembodiments illustrated in the drawings and specific language will beused to describe the same. It will nevertheless be understood that nolimitation of the scope of the disclosure is thereby intended. Anyalterations and further modifications of the inventive featuresillustrated herein, and any additional applications of the principles ofthe disclosure as illustrated herein, which would normally occur to oneskilled in the relevant art and having possession of this disclosure,are to be considered within the scope of the disclosure claimed.

It must be noted that, as used in this specification and the appendedclaims, the singular forms “a,” “an,” and “the” include plural referentsunless the context clearly dictates otherwise.

In describing and claiming the present disclosure, the followingterminology will be used in accordance with the definitions set outbelow.

As used herein, the terms “comprising,” “including,” “containing,”“characterized by,” and grammatical equivalents thereof are inclusive oropen-ended terms that do not exclude additional, unrecited elements ormethod steps.

As used herein, the terms “virtual,” and “hologram” are usedinterchangeably, and grammatical equivalents thereof are inclusive oropen-ended terms that do not exclude additional, unrecited elements ormethod steps. These terms are used to describe visual representations ofan actual physical device or element, having all, or mostly all, of thesame visual characteristics of the physical device, including size andshape.

Applicant has discovered a novel system and method for generating andusing a virtual jig, or virtual instrument, in a surgical procedure, forexample, in a knee or tibial implant procedure, or other desiredsurgical procedure.

The phrase “virtual system” as used herein, shall refer broadly to anysystem capable of generating or creating a simulated or virtualrendering or projection of physical or structural features identical orsubstantially identical to an actual physical device, instrument orother physical structure, as known in the art. A virtual system may alsoinclude a device, mechanism, or instrument capable of projecting ordisplaying the desired a simulated or virtual rendering or projection ofphysical or structural features identical or substantially identical toan actual physical device. A virtual system may also enable a user tomanipulate, move and/or modify the simulated or virtual rendering orprojection.

The phrase “mixed or augmented reality system” as used herein, shallrefer broadly to any system capable of generating or creating asimulated or virtual rendering or projection of physical or structuralfeatures identical or substantially identical to an actual physicaldevice, instrument or other physical structure, as known in the art. Amixed or augmented reality system may also include a device, mechanism,or instrument capable of projecting or displaying the desired asimulated or virtual rendering or projection of physical or structuralfeatures identical or substantially identical to an actual physicaldevice overlaid or concurrently with actual physical structures,mechanism or devices in reality, thus incorporating the virtualrendering or projection in real world settings with actual physicalelement. A mixed or augmented reality system may also enable a user tomanipulate, move and/or modify the simulated or virtual rendering orprojection.

The phrase “mixed or augmented reality instrument” as used herein, shallrefer broadly to any device, mechanism or instrument used in a mixed oraugmented reality system, including a device capable of generating orcreating a simulated or virtual rendering or projection of physical orstructural features identical or substantially identical to an actualphysical device, instrument or other physical structure, as known in theart. A mixed or augmented reality instrument may also be capable ofprojecting or displaying the desired a simulated or virtual rendering orprojection of physical or structural features identical or substantiallyidentical to an actual physical device overlaid or concurrently withactual physical structures, mechanism or devices in reality, thusincorporating the virtual rendering or projection in real world settingswith actual physical element. A mixed or augmented reality instrumentmay also enable a user to manipulate, move and/or modify the simulatedor virtual rendering or projection.

The phrase “holographic representation” as used herein, shall referbroadly to a visual rendering or projection representing an actualphysical device or element, having all, or mostly all, of the samevisual characteristics of the corresponding physical device or element,including size and shape, as known in the art.

Referring to FIGS. 1-3, in a disclosed embodiment a mixed or augmentedsystem 100, which can be used to produce, or display, a desired mixed oraugmented reality instrument, such as a virtual jig or cutting guide ina display to a surgeon or user, or stated another way, that is visibleand manipulatable by a surgeon or user. The mixed or augmented realitysystem 100 may also enable a user to activate or deactivate, in full orin part, the virtual instrument or instruments, making a virtualinstrument appear or disappear, as desired in a mixed reality assistedsurgery, for example.

The mixed or augmented reality system 100 may include a mixed oraugmented reality headset 102 which may include a transparent or mostlytransparent viewer 104 which can be suspended or positioned in front ofa user's eyes. The headset 102 may include a headband 106 attached tothe viewer 104, which may be used to secure the headset 102 to a user'shead 108, thereby securing the viewer 104 in place in front of theuser's eyes.

The transparent viewer 104 may be configured to project, or otherwisemake viewable, on an interior surface of the viewer 104, a holographicimage or images, such as a virtual device, for example, a virtualcutting guide, which may be positionally manipulated by the user,surgeon, third party or remote system, such as a remote computer system.The headset 102 may be configured to view holographic images or,alternatively, the holographic images may be turned off and the userwearing the headset 102 may be able to view the surrounding environmentthrough the transparent viewer 104, unobstructed. As such, a user, suchas a surgeon for example, can wear the mixed or augmented realityheadset 102 and then can choose to activate a holographic image to aidein facilitating a surgical procedure and then shut off the holographicimage in order to perform the surgical procedure un-obscured, visually.

One embodiment of the disclosed headset 102 may be a product created andmanufactured by Microsoft, known as the HoloLens® mixed or augmentedreality system, or any suitable mixed or augmented reality system forgenerating virtual images viewable by a user or surgeon. Headset 102 maybe a conventional “off the shelf” product with a built-in platform thatenables all of the features described herein with respect to the headset102. Furthermore, the headset 102, such as a Microsoft HoloLens product,can be loaded or preloaded with all desired or required virtualinstruments, including virtual jigs or surgical cutting guides, virtualdrill bits, and/or a virtual target which can identify relativelocations of a plurality of holes to be drilled by a surgeon tofacilitate the fastening of a jig or other device onto a desired bone atthe proper desired location, and any other desired virtual instrumentsor holograms. The Microsoft HoloLens product and its capabilities andfeatures, or any suitable mixed or augmented reality system such as isdescribed herein with respect to the headset 102, are known to thoseskilled in the art.

The mixed reality system 100 may also include a computer or computersystem 200 having enabling software to communicate with the headset 102,by both receiving information from the headset 102 and transmitting dataand images to the headset 102. It is therefore to be understood, by wayof the circuit diagram and dashed lines shown in FIG. 1, that headset102 is electronically connected to the computer system 200 and a 3Dspatial mapping camera 300. The 3D spatial mapping camera 300 iselectronically connected to the headset 102 and the computer system 200,as shown in the circuit diagram and dashed lines shown in FIG. 1. Whilethe 3D spatial mapping camera 300 is electronically connected to theheadset 102, the 3D spatial mapping camera 300 may be separate from andnot mechanically connected to the headset 102.

The mixed reality system 100 may also include a 3D spatial mappingcamera 300. One embodiment of the disclosed spatial mapping camera 300may be a product created and manufactured by Microsoft, known as theAzure Kinect®, or any suitable 3D spatial mapping camera capable ofcontinuous 3D mapping and transition corresponding 3D images, such asbones, anatomy, or other desired 3D objects. The spatial mapping camera300 may be a conventional “off the shelf” product with a built-inplatform that enables all of the features described herein with respectto the spatial mapping camera 200. Furthermore, the spatial mappingcamera 200, such as a Microsoft Azure Kinect product, can be loaded orpreloaded with all necessary software to enable wireless communicationbetween the spatial mapping camera 300 and the computer system 200and/or the headset 102. The Microsoft Azure Kinect product and itscapabilities and features, or any suitable 3D spatial mapping camerasuch as is described herein with respect to the spatial mapping camera300, are known to those skilled in the art.

The headset 102, computer system 200 and spatial mapping camera 300, maybe programmed and configured to enable a surgeon 107 to see andmanipulate a virtual, or holographic target or jig, with respect apatient's bone 400, anatomical, or any other desired location, which mayreceive a surgical implant. The headset 102, computer system 200 andspatial mapping camera 300 may communicate with one another via a localnetwork connection, wifi, bluetooth, or any other known wirelesscommunication signal.

Specifically, the spatial mapping camera 300, that may be programed tocommunicate with the computer system 200 having enabling software, mayutilize such enabling software to map the bone 400, or other desiredanatomy, to help identify the proper location for fastening a jig, orother device, to the bone 400, prior to cutting the knee.

The mixed reality system 100 may also include an alignment jig 500 thatcan be secured to the exposed bone 400, or other desired anatomy. Thejig 500 may includes a first marker 502 which may be attached to the jig500 at a fixed location on the bone 400. The first marker 502 mayinclude a scanable, visual, optical label 404, such as a QR code. Thejig 500 may also include a second marker 510 that may be moveable withrespect to the jig 500 and the bone 400. The second marker 510 may alsoinclude a scanable, visual, or optical label 412, such as a QR code.

The surgeon may attach the jig 500 to the exposed bone 400, at apredetermined or desired location. The spatial mapping camera 300 mayspatially map the jig 500 and the exposed bone 400, to map the surfaceof the exposed bone and relative location of the jig 500.

The surgeon may then utilize the headset 102 to scan the fixed scanablelabel 504 of the first marker 502 and send the corresponding informationto the computer system 200. The computer system 200 may then utilizedata from the 3D spatial mapping camera 300 and the scanable label 502of the first marker 502 to determine the orientation of the moveablesecond marker 510 and send the data to the headset 100, which can thenutilize the data provided by the scanable label 512 tp determine thesubstantially exact proper location of the second marker 510. Thisidentified position of the second marker 510 may be viewed by thesurgeon in a holographic image. The surgeon can then manipulate thesecond marker 510 in the holographic image, until the proper position isset and determined.

Once the proper position of the second marker 510 is set in theholographic image the surgeon can use the headset 102 to lock theholographic image in place. Then the surgeon can manipulate the actualphysical second marker 510 to substantially match the positioning of theset rendering of the second marker 510. A target 514 located on thesecond marker 510 may provide the surgeon with the substantially exactlocation to drill a required hole, or place a pin, with respect to theexposed bone 400, such that the surgeon can manipulate the location ofthe jig with respect to the bone 400, to substantially match thelocation of the virtual jig, or holographic image 900, with respect to avirtual bone.

The headset 102 may help facilitate the proper orientation of the secondmarker 510, and corresponding target 514, by illuminating the target 514or providing a colored symbol, each of which may include a color, suchas red, that may change colors, such as changing from red to green, whenthe target is ultimately moved into the proper position, by operation ofa microprocessor (not shown) contained within headset 102 or computersystem 200, said processor being programed as known to those skilled inthe art of programming to trigger a change of color when the target ismoved into the proper position.

As shown in FIGS, 2-5 the jig 500 may include a frame 515 that may begenerally U-shaped, although alternative shapes may also be used, suchas a V-shape, semi-circle, or any other desired shape, for example. Apartially enclosed, or open-ended shape may provide a surgeon or userwith the ability to manipulate the position of the second marker 510over a broader range of motion.

The jig 500 may include a plurality of pin holes 520, in the frame 515,which can be configured to receive corresponding pins 522 which canremovably attach the jig 500 to the bone 400.

The frame 515 of the jig 500 may also include slot 525 that extendsthrough at least a portion of the frame 515. The slot may also lie insubstantially the same plane as the frame 515 or substantially parallelto the plane of the frame 515. The slot 525 may be configured to receiveat least a portion of the second marker 510.

The second marker 510 may be formed having a substantially rectangularcross-section, such that the second marker 515 includes at least a pairof opposing, substantially planar side surfaces 510 a and 510 b. Thesecond marker 510 may also be formed in a generally linear shape, asshown, but may alternatively be bent, angled, or have any other desiredshape.

The slot 525 of the frame 515 may be shaped and configured to receivethe second marker 510 in a friction fit relationship, such that thesecond marker 510 can be inserted into the slot 525 of the frame 515 andpositionally manipulated, laterally, horizontally or in any desireddirection, with respect to the frame 515. The slot 515 enables thesecond marker 510 to move translationally 360 degrees, with respect tothe frame 515, within a single plane, where such a plane issubstantially coplanar with a plane formed by the slot 525.

Once the second marker 510 is located in a desired position within theslot 525 with respect to the frame 515, locking pins 530 may be threadedthrough the frame 515 and slot 525 and fastened, such that a portion ofthe frame 515 adjacent to the portion of the second marker 510 withinthe slot 525 is biased against the second marker 510, locking the secondmarker 510 in place, relative to the frame 515 and slot 525. While thelocking pins 530, may be in a threaded relationship with the fame 515,other mocking mechanisms know in the art may alternatively be used.

The jig 500 may also include a third marker 540 that may be identical,or substantially identical, to the structure of the second marker 510,and may be used in the same or substantially the same way in the mixedreality system as the second marker.

The first, second, and third markers 502, 510, and 540 may be configuredsuch that scanable labels, such as 504 and 512 may be removably securedthereto. These scanable labels 504 and 512, or other similar labels, maybe removably secured to respective markers 502, 510 and 540 via frictionfit, snap fit, or any other desired securement method. This removableconnection enables a surgeon or user to interchange labels betweenmarkers or replace or otherwise change labels before, during or after aprocedure.

As shown in FIGS. 4 and 5, in another embodiment the jig 500 may beremovably secured to a mounting plate 600. The mounting plate 600 mayinclude a concave or curved surface 602 that may be shaped and/orconfigured to abut or receive a portion of a bone, portion of anatomy,or another desired object. The mounting plate may include a pair of keyfeatures 604, that may be configured to be received in corresponding keyways 570 formed in the frame 515. The key 604 and key way 570 engagementenables the jig 500 to be removably engaged with the mounting plate 600,such that the jig 500 may be secured to the mounting plate 600 before asurgical procedure has begun, or after the mounting plate 600 hasalready been positioned with respect to a bone, portion of anatomy, oranother desired object.

Due to the accuracy of the disclosed method and system, the jig 500 maybe made of plastic, metal, polyamide, or any other desired material.Manufacturing the jig 500 out of a plastic or polyamide material, orother relatively inexpensive material, may allow the jig 500 to bedisposable, while still maintaining the precision and accuracy oftraditional metal jigs. The jig 500 may also be manufactured using a 3Dprinter, which can further reduce the cost of manufacturing and storageof jigs, since 3D printed jigs could be made on demand, customized tothe size and shape required by individual patients and users. Thephysical jig 500 may also be manufactured using any other knowntechnique for forming a physical jig.

In the foregoing Detailed Description, various features of the presentdisclosure are grouped together in a single embodiment for the purposeof streamlining the disclosure. This method of disclosure is not to beinterpreted as reflecting an intention that the claimed disclosurerequires more features than are expressly recited in each claim. Rather,as the following claims reflect, inventive aspects lie in less than allfeatures of a single foregoing disclosed embodiment. Thus, the followingclaims are hereby incorporated into this Detailed Description of theDisclosure by this reference, with each claim standing on its own as aseparate embodiment of the present disclosure.

It is to be understood that the above-described arrangements are onlyillustrative of the application of the principles of the presentdisclosure. Numerous modifications and alternative arrangements may bedevised by those skilled in the art without departing from the spiritand scope of the present disclosure are intended to cover suchmodifications and arrangements. Thus, while the present disclosure hasbeen shown in the drawings and described above with particularity anddetail, it will be apparent to those of ordinary skill in the art thatnumerous modifications, including, but not limited to, variations insize, materials, shape, form, function and manner of operation, assemblyand use may be made without departing from the principles and conceptsset forth herein.

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 23. A method of determining alocation for a surgical procedure, comprising: attaching a jig to abone, wherein the jig includes: a frame; a first marker fixed to theframe, wherein the first marker includes a scanable label; a secondmarker moveably connected to the frame, such that the second marker canmove positions independent of the frame, and wherein the second markerincludes a scanable label; providing a 3D spatial mapping camera;spatially mapping the jig and the bone using the 3D spatially mappingcamera to identify a location for the surgical procedure; scanning thescanable label of the first marker and the scanable label of the secondmarker to identify a location for the second marker; and manipulate aposition of the second marker to the identified location.
 24. The methodof claim 23, further comprising: providing a mixed reality headsetconfigured to scan the scanable label of the first marker and thescanable label of the second marker, to provide location data to themixed reality headset.
 25. The method of claim 23, wherein the firstmarker is fixed to the frame such that the first marker does not moveindependent of the frame.
 26. The method of claim 23, wherein thescanable label of the first marker includes data receivable by the mixedreality headset related to the jig.
 27. The method of claim 23, whereinthe scanable label of the second marker includes data receivable by themixed reality headset related to a determined position of the secondmarker.
 28. The method of claim 23, wherein the second marker includes atarget, configured to identify a location to drill.
 29. The method ofclaim 23, wherein the frame includes a slot configured to receive thesecond marker, wherein the second marker may move laterally, withrespect to the frame, within the slot.
 30. The method of claim 29,wherein the slot is configured to receive the second marker with afriction fit engagement.
 31. The method of claim 23, further comprisinga mounting plate fastened to the frame and configured to abut a bone.32. The method of claim 23, wherein the scanable label of the firstmarker is removable.
 33. The method of claim 23, wherein the scanablelabel of the second marker is removable.
 34. (canceled)
 35. A method ofdetermining a location for a surgical procedure, comprising: attaching ajig to a bone, wherein the jig includes: a frame; a first marker fixedto the frame, wherein the first marker includes a scanable label; asecond marker moveably connected to the frame, such that the secondmarker can move positions independent of the frame, and wherein thesecond marker includes a scanable label; providing a 3D spatial mappingcamera; providing a mixed reality headset configured to communicate withthe 3D mapping camera; spatially mapping the jig and the bone using the3D spatially mapping camera to identify a location for the surgicalprocedure; sending a determined location of the second marker from the3D spatial mapping camera to the mixed reality headset, such that themixed reality headset provides an image of the determined location forthe second marker relative to the bone; and manipulating a position ofthe second marker to the identified location.
 36. The method of claim35, further comprising: scanning the scanable label of the first markerand the scanable label of the second marker to identify the determinedlocation for the second marker.
 37. The method of claim 35, wherein thefirst marker is fixed to the frame such that the first marker does notmove independent of the frame.
 38. The method of claim 35, wherein thescanable label of the first marker includes data receivable by the mixedreality headset related to the jig.
 39. The method of claim 35, whereinthe scanable label of the second marker includes data receivable by themixed reality headset related to a determined position of the secondmarker.
 40. The method of claim 35, wherein the second marker includes atarget, configured to identify a location to drill.
 41. The method ofclaim 35, wherein the frame includes a slot configured to receive thesecond marker, wherein the second marker may move laterally, withrespect to the frame, within the slot.
 42. The method of claim 41,wherein the slot is configured to receive the second marker with afriction fit engagement.
 43. The method of claim 35, further comprisinga mounting plate fastened to the frame and configured to abut a bone.44. A method of determining a location for a surgical procedure,comprising: attaching a jig to a bone, wherein the jig includes: aframe; a first marker fixed to the frame, wherein the first markerincludes a scanable label; a second marker moveably connected to theframe, such that the second marker can move positions independent of theframe, and wherein the second marker includes a scanable label;providing a mixed reality headset; scanning the scanable label of thefirst marker and the scanable label of the second marker with the mixedreality headset to identify a location for the second marker using themixed reality headset; and manipulating a position of the second markerto the identified location.
 45. The method of claim 44, furthercomprising: providing a 3D spatial mapping camera; and spatially mappingthe jig and the bone using the 3D spatially mapping camera to identify alocation for the surgical procedure.
 46. The method of claim 44, whereinthe first marker is fixed to the frame such that the first marker doesnot move independent of the frame.
 47. The method of claim 44, whereinthe scanable label of the first marker includes data receivable by themixed reality headset related to the jig.
 48. The method of claim 44,wherein the scanable label of the second marker includes data receivableby the mixed reality headset related to a determined position of thesecond marker.
 49. The method of claim 44, wherein the second markerincludes a target, configured to identify a location to drill.
 50. Themethod of claim 44, wherein the frame includes a slot configured toreceive the second marker, wherein the second marker may move laterally,with respect to the frame, within the slot.
 51. The method of claim 50,wherein the slot is configured to receive the second marker with afriction fit engagement.
 52. The method of claim 44, further comprisinga mounting plate fastened to the frame and configured to abut a bone.53. A method of determining a location for a surgical procedure,comprising: providing a 3D spatial mapping camera; providing a mixedreality headset; attaching a jig to a bone, wherein the jig includes: aframe; a first marker fixed to the frame, wherein the first markerincludes a removable scanable label, wherein the first marker is fixedto the frame such that the first marker does not move independent of theframe and the scanable label of the first marker includes datareceivable by the mixed reality headset related to the jig; a secondmarker moveably connected to the frame, such that the second marker canmove positions independent of the frame, and wherein the second markerincludes a removable scanable label that includes data receivable by themixed reality headset related to a determined position of the secondmarker and wherein the second marker also includes a target, configuredto identify a location to drill; a mounting plate fastened to the frameand configured to abut a bone; wherein the frame includes a slotconfigured to receive the second marker, wherein the second marker maymove laterally, with respect to the frame, within the slot and whereinthe slot is configured to receive the second marker with a friction fitengagement; spatially mapping the jig and the bone using the 3Dspatially mapping camera to identify a location for the surgicalprocedure; scanning the scanable label of the first marker and thescanable label of the second marker with the mixed reality headset toidentify a location for the second marker using the mixed realityheadset; and manipulating a position of the second marker to theidentified location.